Bottom Line:
The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid.A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve.The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis.

ABSTRACTWe report a case of a 74-year-old female, with a mitral heart valve, who presented with pain and blurred vision in the right eye for 2 days. Her visual acuity was light perception (LP) in the right eye and 20/40 in the left eye. Slit lamp examination showed corneal edema and hypopyon, and a view of the right fundus was impossible. Echography showed vitreous condensation. One day after presentation, the patient developed acute lung edema requiring hospitalization, so she was not submitted to vitreous tap and intravitreal treatment. The cardiac and systemic evaluations revealed a mitral endocarditis secondary to Enterococcus faecalis. The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid. Her visual acuity remained as no LP, and her intraocular pressure (IOP) has been controlled with brimonidine bid despite developing a total cataract with 360° posterior synechia. A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve. The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis.

Mentions:
Due to her past medical history and after medical stabilization, transesophageal echocardiography was performed, showing cardiac mitral atherosclerotic valve vegetation. We made a diagnosis of endogenous endophthalmitis secondary to prosthetic endocarditis. She was hospitalized with intravenous vancomycin and gentamycin for 3 weeks and oral linezolid at home for 2 months. After five weeks, the patient complained of right ocular pain. At examination, ocular pressure was 46 mmHg and biomicroscopy revealed Descemet's folds and hyphema without hypopyon (Figure 4).

Mentions:
Due to her past medical history and after medical stabilization, transesophageal echocardiography was performed, showing cardiac mitral atherosclerotic valve vegetation. We made a diagnosis of endogenous endophthalmitis secondary to prosthetic endocarditis. She was hospitalized with intravenous vancomycin and gentamycin for 3 weeks and oral linezolid at home for 2 months. After five weeks, the patient complained of right ocular pain. At examination, ocular pressure was 46 mmHg and biomicroscopy revealed Descemet's folds and hyphema without hypopyon (Figure 4).

Bottom Line:
The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid.A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve.The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis.

ABSTRACTWe report a case of a 74-year-old female, with a mitral heart valve, who presented with pain and blurred vision in the right eye for 2 days. Her visual acuity was light perception (LP) in the right eye and 20/40 in the left eye. Slit lamp examination showed corneal edema and hypopyon, and a view of the right fundus was impossible. Echography showed vitreous condensation. One day after presentation, the patient developed acute lung edema requiring hospitalization, so she was not submitted to vitreous tap and intravitreal treatment. The cardiac and systemic evaluations revealed a mitral endocarditis secondary to Enterococcus faecalis. The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid. Her visual acuity remained as no LP, and her intraocular pressure (IOP) has been controlled with brimonidine bid despite developing a total cataract with 360° posterior synechia. A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve. The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis.